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ND has a unique worker population and poses unique challenges for occupational health and safety programs in the oil and gas industry. Despite the challenges faced, it is possible to take lessons learned from other states that are demographically similar, such as certain counties in Colorado, Montana, and Wyoming who have had similar changes in their worker population, and who have experienced high rates of occupational fatalities in this industry. It is imperative to establish and maintain working partnerships between oil and gas industry and health and safety stakeholders and to build an infrastructure conducive to preventing and controlling fatalities in the workplace.

Oil and gas companies need to prioritize the health and safety of their workers in order to retain workers, expand the industry and improve perception of the industry. Targeted programs and policies are necessary to maximize participation and meet the 'bottom line' of both oil and gas organizations that have an interest in promoting health and safety. Surveillance of injuries must be consistent, complete and accurate in order to identify problem areas related to this worker population.

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